Oppositional Defiant Disorder

What Is Oppositional Defiant Disorder?

Oppositional defiant disorder (ODD) is an impulse control disorder that causes school-age children and teens to display patterns of uncooperative, defiant, and angry behavior toward authority figures.

These behavior problems often disrupt the child’s school life and home life, as well as the child’s relationships.

ODD is considered among the disruptive behavior disorders, which also includes conduct disorder. Disruptive behavior disorders typically include indifference, defiance, or aggression towards others.

Children with ODD may engage in constant back-talking, disagreeableness, and even aggressive behavior when upset.

If left untreated, ODD can lead to conduct disorder, a more severe and violent impulse control disorder with grim outcomes for the child as they enter adulthood.

Common Co-Morbidities with ODD

ODD commonly occurs along with other key mental or neurodevelopmental conditions. Most children and teens with ODD and oppositional behavior have at least one other mental health condition.

Common co-occurring conditions with ODD include:

• Other impulse control disorders
• Learning differences or disabilities
• Attention-deficit/hyperactivity disorder (ADHD)
• Mood disorders, such as depression or bipolar disorder
• Anxiety disorders, including obsessive-compulsive disorder (OCD)
• Personality disorders

Prevalence of Oppositional Defiant Disorder

According to current research, around 3.3% of US children have ODD. In addition, around 40% of children with ADHD also have oppositional defiant disorder or a related conduct disorder.

About 30% of children diagnosed with ODD will develop conduct disorder.

ODD is one of the more common impulse control disorders. The prevalence of other impulse control disorders includes:

• Conduct disorder: 4% of children
• Intermittent explosive disorder: 2.7% of people
• Kleptomania: 0.6% of people
• Pyromania: >1% of people

Symptoms of Oppositional Defiant Disorder

Oppositional defiant disorder is characterized by consistent defiance, misbehavior, and spiteful reactions while angry or upset. The symptoms of ODD are far more severe than the typical rebellious or uncooperative behavior common with normal adolescent development.

Common symptoms of oppositional defiant disorder include:

• Defiant behavior and conduct problems, especially with figures of authority like parents, teachers, and community leaders
• Consistent and excessive arguing with adults and authority figures
• Refusing to do what adults ask or constantly questioning rules or requests
• Spitefulness or vindictiveness towards others while upset or angry
• Frequent temper tantrums and explosions of anger
• Seeking revenge on others when angry
• Hostile behavior done purposely to upset others, especially when in an irritable mood

Oppositional Defiant Disorder and Addiction

Unfortunately, drug and alcohol abuse is common for children and teens with ODD. For many adolescents with ODD, abusing substances is a way of coping with symptoms of depression, anxiety, and anger.

Most children with ODD have co-occurring mental health conditions that can cause unpleasant symptoms they may struggle to manage or regulate. According to the University of Arkansas for Medical Sciences, children with ODD are six times more likely to suffer from a substance use disorder.

Causes of Oppositional Defiant Disorder

Researchers aren’t sure of the exact cause of ODD. However, current research indicates that issues with parent/child relationships, genetic impacts, and environmental factors cause ODD.

Children whose parents have a history of mental health conditions are more likely to have issues themselves.

In the case of ODD, a family history of impulse control disorders, personality disorders, mood disorders, and addiction can make a child more likely to have ODD and other mental illnesses.

The environment in which the child is raised can also play a tremendous factor in ODD. Inconsistent discipline or reinforcement of inappropriate actions can lead to the problem behaviors seen in ODD. In addition, neglectful or abusive households can contribute to the development of ODD.

Risk Factors for Oppositional Defiant Disorder

There are a few risk factors that can lead to ODD symptoms and possibly developing ODD. Not all children with these risk factors will develop ODD, but many will.

Common risk factors associated with the development of oppositional defiant disorder include:

• Being male
• Family history of mental illness and addiction
• Inconsistent parenting and discipline that leads to reinforcing the wrong behaviors
• Hanging out with peers who are violent or rule-breaking
• Other mental illnesses, such as mood disorders, anxiety disorders, personality disorders, impulse control disorders, and neurodevelopmental disorders like ADHD and learning differences

Effective Treatment for Oppositional Defiant Disorder

Oppositional defiant disorder must first be diagnosed before beginning treatment. A mental health professional specializing in adolescent psychiatry will first interview the child and their caregivers to determine the symptoms.

The healthcare provider will then compare symptoms to the diagnostic criteria listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) to rule out other conditions.

Once a diagnosis is obtained, psychotherapy is the most common and effective treatment.

Psychotherapy

Psychotherapy is usually conducted through one-on-one sessions and family therapy, often in the form of parent management training or multisystemic therapy. One-on-one sessions with the child typically include cognitive behavioral therapy (CBT).

Cognitive behavioral therapy (CBT) works by helping the child get to the root of their behaviors and addressing them in a productive, positive way. In family therapy, parent management training can help parents or caregivers better control their child’s behavior while at home through positive parenting.

Multisystemic therapy, on the other hand, is an intensive family and community-based intervention that involves all family members. The therapy works by building positive reinforcement and problem-solving skills to address situations and increasing accountability for problematic behaviors through anger management.

Medications

There are currently no FDA-approved medications for the treatment of ODD. However, due to high rates of comorbidity for children with ODD, medications for other co-occurring disorders may help lessen the severity of ODD symptoms.

Medications sometimes prescribed to help symptoms related to ODD include:

• ADHD medications (stimulants)
• Antidepressants
• Anti-anxiety medications

Get Help for Oppositional Defiant Disorder

Raising a child with ODD can be incredibly challenging for families and teachers. Luckily, there are treatment plans available for ODD, and early intervention is the best way to ensure your child does not escalate to more serious symptoms and conditions.

Speak with your doctor about treatment options to help improve your child’s ODD and family life. If you’re unsure where to start, check out SAMHSA’s online treatment locator or call 1-800-662-4357 (HELP) to learn what clinicians are available in your area.